Management of an anterior abdominal stab wound in a hostile abdomen

摘要

A 54-year-old man presented to our hospital with a single anterior abdominal stab wound by a serrated knife. He had a significant psychiatric history and several prior self-inflicted abdominal stab wounds. He had multiple laparotomies with repair of small bowel injuries and was considered to have a hostile abdomen. His primary survey was unremarkable. His secondary survey was notable for a 12-cm serrated kitchen knife protruding from his mid-abdomen. There was no active bleeding around the knife. On palpation, he had mild localized abdominal tenderness. A lateral abdominal X-ray revealed a significant part of the knife within the peritoneal cavity (Fig. 1). A focused assessment with sonography examination was negative for intra-abdominal fluid. The patient remained hemodynamically stable; therefore, a decision was made to proceed with CT scan. CT of the abdomen and pelvis showed the knife penetrating 6 cm within the abdomen, with foci of intraluminal air and contrast within the soft tissues consistent with small bowel injury (Fig. 2).